Altered brain diffusion tensor imaging indices in adolescents with the Fontan palliation

Sadhana Singh; Bhaswati Roy; Nancy Pike; Ebenezer Daniel; Luke Ehlert; Alan B Lewis; Nancy Halnon; Mary A Woo; Rajesh Kumar

doi:10.1007/s00234-019-02208-x

Altered brain diffusion tensor imaging indices in adolescents with the Fontan palliation

Neuroradiology. 2019 Jul;61(7):811-824. doi: 10.1007/s00234-019-02208-x. Epub 2019 Apr 30.

Authors

Sadhana Singh¹, Bhaswati Roy², Nancy Pike², Ebenezer Daniel¹, Luke Ehlert¹, Alan B Lewis³, Nancy Halnon⁴, Mary A Woo², Rajesh Kumar^{5

6}

Affiliations

¹ Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA.
² UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.
³ Division of Cardiology, Children's Hospital, Los Angeles, CA, USA.
⁴ Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
⁵ Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA. rkumar@mednet.ucla.edu.
⁶ Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA. rkumar@mednet.ucla.edu.

Abstract

Purpose: Single ventricle heart disease (SVHD) patients show injury in brain sites that regulate autonomic, mood, and cognitive functions. However, the nature (acute or chronic changes) and extent of brain injury in SVHD are unclear. Our aim was to examine regional brain tissue damage in SVHD over controls using DTI-based mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) procedures.

Methods: We collected two DTI series (3.0-T MRI), mood and cognitive data, from 27 SVHD and 35 control adolescents. Whole-brain MD, AD, RD, and FA maps were calculated from each series, realigned and averaged, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates, age and sex; false discovery rate, p < 0.05). Region-of-interest analyses were performed to calculate MD, AD, RD, and FA values for magnitude assessment between groups.

Results: SVHD patients showed impaired mood and cognitive functions over healthy adolescents. Multiple brain sites in SVHD showed increased MD values, including the insula, caudate, cingulate, hypothalamus, thalamus, medial prefrontal and frontal cortices, parahippocampal gyrus, hippocampus, precentral gyrus, amygdala, cerebellum, corpus callosum, basal forebrain, mammillary bodies, internal capsule, midbrain, fornix, and occipital, parietal, and temporal cortices, indicating chronic tissue changes. Similar areas showed either increased AD or RD values, with RD changes more enhanced over AD in SVHD compared to controls. Few brain regions emerged with increased or decreased FA values in SVHD patients over controls.

Conclusion: SVHD adolescents, more than a decade from their last surgical procedure, show widespread brain abnormalities in autonomic, mood, and cognitive regulatory areas. These findings indicate that brain injury is in a chronic stage in SVHD with predominantly myelin changes that may result from previous hypoxia/ischemia- or developmental-induced processes.

Keywords: Brain injury; Cognition; Diffusion tensor imaging; Single ventricle heart disease.

MeSH terms

Adolescent
Anisotropy
Brain Diseases / diagnostic imaging*
Diffusion Tensor Imaging / methods*
Female
Fontan Procedure*
Humans
Male
Surveys and Questionnaires

Abstract

MeSH terms

Grants and funding